So, as a physician specializing in preventive medicine, and with a long-standing interest in cardiac risk modification specifically, it makes sense for me to weigh in here. Perhaps some of my faithful readers -- and my thanks for that, by the way -- have been waiting for my verdict. So here you go: The answer may not matter a lot, because it's the wrong question.

I guess it's only fair to note that I have held back from entering this fray for two reasons, one lesser and one greater. The lesser reason is that we really don't yet know the right answer. If it were truly clear exactly what criteria for statin use were best, there would be no controversy in the first place. There appear to be strengths and weaknesses to both sets of criteria, the old and the new. Either way, it's clear that statins -- which in fact are rather good drugs -- can and do save lives when prescribed judiciously. The debate is all about what "judiciously" really means, and what is most judicious.

Frankly, I don't think anyone knows for sure yet. To know with genuine certainty, we would need to randomize thousands of people to statin prescription by the old method, and thousands more to statin prescription by the new method, and see which group had less heart disease and premature death over time. Until or unless that is done -- don't hold your breath -- we have competing expert opinions with no clear basis in empirical evidence to declare a winner.

As noted, that is the lesser reason for my apparent abdication. The greater reason is that I think it's the wrong question. The right question is: How can a society look on passively at a situation that invites tens of millions of its citizens (no matter what criteria are used) to take a drug to fix what feet and forks could fix better, at lower cost, more universally, and absent the risk of side effects?

As far as I'm concerned, the entire debate about statins is part of our societal static. It's a background noise of cultural misdirection that favors the conflated interests of Big Food and Big Pharma while ignoring the compelling, consistent, signal of what lifestyle as medicine could do for us all.

But for the most part, we as individuals, and collectively as a culture, seem deaf to this signal. We watch our peers and parents succumb to heart disease, and wring our hands. We fret over the same fate overtaking us. We get prescriptions for drugs we wish we didn't have to take, worry about serious side effects, suffer through minor ones, grumble about copays, and implicate ourselves in the unmanageable burden of "health" care costs.

And so our debate about statins, seemingly so important, plays out in the static of the status quo. No matter who wins the debate about statin indications, we the people -- the tens of millions of people who, either way, are missing the signal and will wind up taking drugs to fix what lifestyle could fix better -- lose.

-fin

Dr. Katz is the President-elect of the American College of Lifestyle Medicine. In his latest book, DISEASE PROOF, he lays out the skill set necessary, and on which he and his family rely, to make lifestyle the best of all medicine. DISEASE PROOF is available in bookstores nationwide and at: